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Year : 2017  |  Volume : 29  |  Issue : 4  |  Page : 235-236

May–Thurner syndrome caused by a huge uterine myoma

Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan

Date of Submission07-Jun-2017
Date of Decision27-Jul-2017
Date of Acceptance31-Jul-2017
Date of Web Publication4-Dec-2017

Correspondence Address:
Chi-Feng Hsu
Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, 539, Zhongxiao Road, East District, Chiayi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tcmj.tcmj_126_17

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How to cite this article:
Chang SC, Tsai MJ, Hsu CF. May–Thurner syndrome caused by a huge uterine myoma. Tzu Chi Med J 2017;29:235-6

How to cite this URL:
Chang SC, Tsai MJ, Hsu CF. May–Thurner syndrome caused by a huge uterine myoma. Tzu Chi Med J [serial online] 2017 [cited 2022 Aug 14];29:235-6. Available from: https://www.tcmjmed.com/text.asp?2017/29/4/235/219748

A 45-year-old woman presented to our emergency department with a chief complaint of swelling and pain in her left calf and thigh for 2 days. She had a huge uterine myoma with hypermenorrhea for a couple of years and had been taking an oral contraceptive consisting of cyproterone and ethinyl estradiol (Diane-35) prescribed by a gynecologist for the past 16 days. She denied previous medical disease, recent trauma, recent abdominal surgery, and long-term immobilization. A physical examination revealed a swollen, painful left lower limb. Blood tests revealed normal cell counts and coagulation profiles, but she had a significantly elevated D-dimer level (>10,000 μg/L). Ultrasonography of the lower limbs revealed non-compressible left femoral and popliteal veins. Subsequent contrast-enhanced computed tomography venography showed left femoral deep vein thrombosis (DVT) [Figure 1], arrows]. Compression of the left common iliac vein [Figure 2], white arrows] by the overlying huge uterine myoma (asterisk) and right common iliac artery (black arrows) was also found [Figure 2]. A variant of May–Thurner syndrome was suspected. After admission, thrombolytic therapy with urokinase and enoxaparin were initiated. Her condition improved rapidly, and she was discharged uneventfully 3 days later. She was referred to a gynecologist for surgical evaluation of the huge uterine myoma because the DVT could recur if the anatomical lesion was not removed.
Figure 1: Enhanced computed tomography venography of the lower limbs shows a swollen left thigh and a filling defect in the left femoral vein (arrows)

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Figure 2: Serial enhanced computed tomography venography in sequence from (a-f) shows the left common iliac vein (white arrows), which is compressed by the overlying right common iliac artery (black arrows), the uterine myoma (asterisk) and the underlying vertebral body

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May–Thurner syndrome (or iliocaval compression syndrome) is defined as a compression of the iliac vein that results in decreased flow in the vein and the left lower extremity due to a vascular malformation. It may result in left leg edema, pain, iliofemoral DVT, and postthrombotic syndrome. Compression of the left common iliac vein by the right common iliac artery against the underlying fifth lumbar vertebra is the typical underlying malformation [1],[2]. It is rarely diagnosed but is prevalent in postmortem examinations. Hence, it is thought to be underestimated. Various conditions resulting in compression of the left common iliac vein by the right common iliac artery and underlying spine which lead to the development of left femoral DVT have been reported, including prolonged immobilization, dehydration, contractive therapy, surgical procedures for abdominal, gynecological, or spinal pathology, multiple pregnancies, and postpartum conditions [2],[3],[4],[5],[6]. However, May–Thurner syndrome secondary to a huge uterine myoma has not been reported previously.

Pharmacological treatment, endovascular intervention, and surgical management have all been proposed as treatments [1], but there is currently no consensus. Furthermore, definitive treatment should be tailored to each patient as the condition varies. Familiarity with May–Thurner syndrome as an etiology of unilateral DVT is important, because of possible recurrence of thrombosis, pulmonary embolism, and postthrombotic syndrome, which could lead to significant morbidity and mortality. The key to successful treatment in May–Thurner syndrome-related DVT is to correct the anatomical lesion along with the removal of the clot and use of anticoagulation.

Declaration of patient consent

The authors certify that the patient has obtained an appropriate patient consent form. In the form, the patient has given her consent for her images and clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Donatella N, Marcello BU, Gaetano V, Massimo P, Massimo M, Giancarlo B, et al. What the young physician should know about May-Thurner syndrome. Transl Med UniSa 2015;12:19-28.  Back to cited text no. 1
Im S, Lim SH, Chun HJ, Ko YJ, Yang BW, Kim HW, et al. Leg edema with deep venous thrombosis-like symptoms as an unusual complication of occult bladder distension and right May-Thurner syndrome in a stroke patient: A case report. Arch Phys Med Rehabil 2009;90:886-90.  Back to cited text no. 2
Campsen J, Bang TJ, Kam I, Gupta R. May-Thurner syndrome complicating left-sided renal transplant. Transplantation 2010;89:904-6.  Back to cited text no. 3
O'Sullivan GJ. The role of interventional radiology in the management of deep venous thrombosis: Advanced therapy. Cardiovasc Intervent Radiol 2011;34:445-61.  Back to cited text no. 4
Baron HC, Shams J, Wayne M. Iliac vein compression syndrome: A new method of treatment. Am Surg 2000;66:653-5.  Back to cited text no. 5
Patel NH, Stookey KR, Ketcham DB, Cragg AH. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome. J Vasc Interv Radiol 2000;11:1297-302.  Back to cited text no. 6


  [Figure 1], [Figure 2]

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